免疫抑制治疗皮肤病、风湿病和胃肠病患者的麻风病检出率：文献系统评价和荟萃分析。

Leprosy detection rate in patients under immunosuppression for the treatment of dermatological, rheumatological, and gastroenterological diseases: a systematic review of the literature and meta-analysis.

机构信息

Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília - UnB, Campus Universitário Darcy Ribeiro, Brasília, DF, CEP 70910-900, Brazil.

Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis - DCCI, Coordenação Geral de Vigilância das Doenças em Eliminação - CGDE, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brazil.

出版信息

BMC Infect Dis. 2021 Apr 13;21(1):347. doi: 10.1186/s12879-021-06041-7.

BACKGROUND

Recently developed immunosuppressive drugs, especially TNF antagonists, may enhance the risk of granulomatous infections, including leprosy. We aimed to evaluate the leprosy detection rate in patients under immunosuppression due to rheumatological, dermatological and gastroenterological diseases.

METHODS

We performed a systematic review of the literature by searching the PubMed, EMBASE, LILACS, Web of Science and Scielo databases through 2018. No date or language restrictions were applied. We included all articles that reported the occurrence of leprosy in patients under medication-induced immunosuppression.

RESULTS

The search strategy resulted in 15,103 articles; finally, 20 articles were included, with 4 reporting longitudinal designs. The detection rate of leprosy ranged from 0.13 to 116.18 per 100,000 patients/year in the USA and Brazil, respectively. In the meta-analysis, the detection rate of cases of leprosy per 100,000 immunosuppressed patients with rheumatic diseases was 84 (detection rate = 0.00084; 95% CI = 0.0000-0.00266; I = 0%, p = 0.55).

CONCLUSION

Our analysis showed that leprosy was relatively frequently detected in medication-induced immunosuppressed patients suffering from rheumatological diseases, and further studies are needed. The lack of an active search for leprosy in the included articles precluded more precise conclusions.

TRIAL REGISTRATION

This review is registered in PROSPERO with the registry number CRD42018116275 .

背景

最近开发的免疫抑制剂，特别是 TNF 拮抗剂，可能会增加包括麻风病在内的肉芽肿性感染的风险。我们旨在评估因风湿、皮肤和胃肠疾病而接受免疫抑制治疗的患者中麻风病的检出率。

方法

我们通过检索 PubMed、EMBASE、LILACS、Web of Science 和 Scielo 数据库，对截至 2018 年的文献进行了系统评价。未对检索时间和语言进行限制。我们纳入了所有报告接受药物诱导免疫抑制治疗的患者中麻风病发生情况的文章。

结果

检索策略共得到 15103 篇文章；最终纳入 20 篇文章，其中 4 篇为纵向设计。在美国和巴西，分别有 0.13 至 116.18 例/10 万患者/年的麻风病检出率。荟萃分析显示，风湿性疾病患者中每 10 万接受免疫抑制治疗的患者中麻风病的检出率为 84 例（检出率=0.00084；95%CI=0.0000-0.00266；I=0%，p=0.55）。